Budget, Caseload Clash At Hospital

Eastern State Is Short On Space And Money

September 22, 2002|By HUGH LESSIG Daily Press

RICHMOND — As state government braces for a new round of budget cuts, Eastern State Hospital is already scrambling to make ends meet.

To control the flow of patients who come through the door, the public mental hospital has generally closed admissions on evenings and weekends for those who volunteer to admit themselves. That began in May.

To balance its own books, Eastern is not spending most of the money earmarked to divert patients to private psychiatric hospitals when its own beds are full. That started in July.

The bottom line: The system is running out of places to put poor people with mental health problems.

Director John Favret said he feels like he's caught between a rock and a hard place. There is a chronic shortage of hospital beds for people who need mental health care in Virginia. But Favret must take court-committed patients. And federal rules forbid him from overcrowding the hospital.

"When we're full, we have to divert," he said.

Add to that the fact that the state's financial problems are complicating matters. Favret is withholding the money he has to divert patients to private hospitals because he thinks he'll need that money to close his own in-house deficit. Statewide, Gov. Mark R. Warner must close a $1.5-plus billion shortage in his two-year budget, and he plans to slash spending by as much as 15 percent per agency.

The trickle-down effects from Eastern State's actions are easy to see. The administrator of a private psychiatric hospital in Hampton said poor patients who would normally go to Eastern State are going to his hospital.

"In May, when they started the closing of hours, it became a problem for me," said Steuart Kimmeth, administrator of the Peninsula Behavioral Center in Hampton. "I don't have anywhere to send them. My charity numbers went up about ten-fold. I'm now the state safety net."

Kimmeth said patients either end up at Eastern State or the Peninsula Behavioral Center, or they call around the state to find other private psychiatric hospitals. (Kimmeth recently took a call from a patient who began calling hospitals in Northern Virginia and ended up calling the Peninsula.)

Patients can end up staying longer in hospital emergency rooms until a bed is available somewhere. That has happened at Riverside Regional Medical Center in Newport News, a spokesman said, although Williamsburg Community Hospital reports no appreciable effect.

Some mental patients can end up in jail for periods of time. Over the past year, the Peninsula Regional Jail has seen an upswing in mental patients who require incarceration, said Maj. Sherry Castellaw, assistant administrator, but nothing that can be tied to any recent changes at Eastern. She said the jail has a good relationship with the hospital.

Howard Cullum directs the Hampton-Newport News Community Services Board, which pre-screens people for admission to ESH.

"State hospitals used to be the safety valve for the community," he said. "When someone had to be moved, the hospitals could always take one more. Now Eastern State has real limits on what it can do. They can't take those people and shoehorn them in."

The two steps taken at Eastern State:

* It has closed to voluntary admissions between 4 p.m. and 8 a.m. Monday through Thursday, and from 4 p.m. Friday to 8 a.m. Monday. Why evenings and weekends? That's when it gets the bulk of its court-committed patients, and it must take those. Also, it has more staff on duty during the day. Favret said this policy is not an outright ban on voluntary admissions during those hours -- the policy is meant to be flexible -- but it's a way to say "give us a break" and have the voluntary patients come in during the day, he said.

* He started the fiscal year on July 1 with $600,000 to compensate private hospitals such as Peninsula that take mental patients when Eastern State is full. Favret is not spending $500,000 of that for now because of his tight budget. This is not related to the upcoming round of budget cuts to be ordered by the Warner administration. Favret has withheld the money to deal with the hospital's internal budget deficit.

Favret said even if he had the full $600,000, it would not last the year. Last year, he spent that much money in a matter of three months because of the volume of admissions. A spokeswoman for the department that oversees Eastern State said Favret is making the best of a tight situation.

"Primarily, he's holding onto that money because of his experience last year" said Martha Mead, a spokeswoman for the Department of Mental Health, Mental Retardation and Substance Abuse Services. "What he's trying to do is manage the dollars as best he can. From our point of view, that's good management."

Del. Phillip A. Hamilton, R-Newport News, isn't so sure. Hamilton, who has sponsored key mental health legislation and is considered a friend to mental health advocates, dashed off a letter to Warner after hearing about the limited hours and the withheld money.

"I think this is symptomatic of a much, much bigger problem," Hamilton said later. "At some point in time, we've got to make a decision that -- while we don't have money today -- we need to generate money because the needs are only going to get worse."

Except the state doesn't have more money. Warner is expected to begin announcing cuts in October.

Virginia's mental health system has no more financial room to maneuver, said Cullum, himself a former state mental health commissioner.

"The system has been stretched the past few years, and it's being stretched more," he said. "The numbers that we're facing now are significantly higher and worse than any time I can remember. In the past, there were other options. Those cards have already been played."

Hugh Lessig can be reached at (804) 225-7345 or by e-mail at hlessig@dailypress.com